Basic Information
| Provider Information | |||||||||
| NPI: | 1356460463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 709 HIDDEN OAK LN | ||||||||
| Address2: | |||||||||
| City: | FRIENDSWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775466091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817704916 | ||||||||
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| Practice Location | |||||||||
| Address1: | 255 FM 51B | ||||||||
| Address2: | |||||||||
| City: | KEMAH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815352439 | ||||||||
| FaxNumber: | 2815352823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 02/05/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA00046 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.